Report: 59M Uninsured Briefly in a Year

Published 8:00 pm, Sunday, May 11, 2003

As few as 21 million Americans lack health insurance year-round, the Congressional Budget Office reported Monday, but up to 59 million are uninsured at least briefly in a given year.

The budget office's estimate for people without coverage all year is as little as half the Census Bureau's figure, which has long been used as a benchmark in the debate over the issue.

No "typical uninsured" emerged from the report, Douglas Holtz-Eakin, the nonpartisan agency's director, said in an interview. "There are two problems, short spells and long-term uninsurance."

Demographic groups likeliest to face long periods without health care coverage include people with lower income, less education and Hispanics, the budget office report said.

Though there is no doubt that extending coverage to more people would be hugely expensive, defining the problem's magnitude is significant because it will affect which policies lawmakers might design to address it.

The battle over covering uninsured Americans is likely to be an important theme in the 2004 presidential campaign and has already emerged as a crucial issue among the Democratic contenders for their party's nomination.

The budget office said nearly half the 59 million are without insurance for less than four months, while an additional 30 percent are uncovered for more than a year. It based its analysis on data from the Census Bureau and other federal sources for 1998, which the report said is the most recent year for which there is reliable data.

Though people who are temporarily uncovered outnumber those without insurance for the entire year, four out of five uninsured people at any one time end up being without coverage for more than a year.

In September, the Census Bureau estimated that 41.2 million people, about 15 percent of U.S. residents who are not elderly, lacked health coverage for all of 2001.

Monday's budget office study said the Census figure overstates the number of people who are uninsured all year. It figured probably 21 million to 31 million Americans were without coverage for all of 1998, saying that number probably has not changed substantially.

Holtz-Eakin said the Census Bureau's data is overstated because survey respondents asked to report their circumstances during the previous year often end up describing their current situation.

He arrived at that conclusion by comparing the data to other Census reports in which people are repeatedly interviewed every few months, and using statistics gathered by the Centers for Disease Control and Prevention, and from the Agency for Healthcare Research and Quality. Both are branches of the Department of Health and Human Services.

The Census Bureau did not immediately respond to a request for comment.

Almost all Americans age 65 and older are covered by Medicare, the health insurance program for the elderly and handicapped. The budget office study examined people too young to qualify for Medicare coverage.

Monday's congressional report could provide ammunition to members of both political parties as they prepare for battles over the issue in Congress and the campaign trail.

Republicans, who generally favor less costly approaches to the problem than Democrats, could cite the budget office's conclusion that there are fewer people without coverage all year than the Census figures indicate.

Democrats could use the 60 million estimate for Americans who lack insurance for at least some period to argue that the need is even more widespread.

Last month, presidential contender Rep. Dick Gephardt, D-Mo., announced a plan to repeal all the tax cuts Bush has pushed through Congress and use the money to cover nearly all uninsured Americans. The highlight of his proposal _ which overall would cost more than $200 billion a year _ would use refundable tax credits to subsidize companies' costs of insuring their workers.

Another candidate, former Vermont Gov. Howard Dean, is proposing a plan his aides say is half as costly as Gephardt's but would help more Americans. He would offer tax incentives to companies that provide coverage, and create a refundable tax credit for uninsured people who can't afford even reduced premiums.

Sen. John Kerry, D-Mass., plans to offer his health care proposal on Thursday.

Bush has proposed spending $89 billion over the next decade for a tax credit that would subsidize up to 90 percent of the costs of health insurance for low- and middle-income people.